Legislature(1997 - 1998)

03/11/1998 09:10 AM Senate HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
       SB 291 - LIV. WILLS/ANATOMICAL GIFTS/PATIENT CARE                       
RALPH BENNETT, legislative aide to Senator Robin Taylor, sponsor of            
SB 291, read the sponsor statement.  SB 291 revises Title 18,                  
Chapter 12, which pertains to rights of the terminally ill.  The               
current statute offers little assurance that an incapacitated                  
person's wishes will be carried out because it states that living              
wills are operative only if the declarant's condition is determined            
to be terminal.                                                                
SB 291 clarifies that an advance directive or living will is given             
operative effect only if it has been medically determined that the             
declarant is in a serious medical condition.   The bill defines                
"medically determined" as a determination from two physicians who              
personally examined the patient, one of whom is the attending                  
physician.  The bill defines "serious medical condition" as: a) a              
terminal condition; b) a permanently unconscious condition; c) a               
condition in which the administration of life-sustaining procedures            
would not benefit the patient's medical condition and would cause              
permanent and severe pain; and d) a progressive illness that will              
be fatal and is in an advanced stage; the person is consistently               
and permanently unable to communicate by any means, to swallow food            
and water safely, to care for the person's self, and to recognize              
the person's family and other people, and it is very unlikely that             
the person's condition will substantially improve.                             
SB 291 was modeled after Oregon law.  That law was cited in a                  
Journal of the American Medical Association study as respecting the            
wishes of the patient.  Section 7 of SB 291 clarifies that nothing             
in this chapter is intended to condone, authorize, or approve mercy            
killing or assisted suicide.  Section 8 sets out conditions under              
which life-sustaining procedures can be withheld when an individual            
does not have a living will.                                                   
CHAIRMAN WILKEN noted Mark Johnson of the Department of Health and             
Social Services (DHSS) and Joe Ambrose of Senator Taylor's staff               
were available to answer questions.                                            
Number 125                                                                     
BRIDGET CARNEY, Corporate Director of Ethics for PeaceHealth, a                
Catholic health care system in Alaska, Washington, and Oregon,                 
testified in favor of SB 291 via teleconference.  Under Oregon's               
Self Determination Act, Peacehealth is able to offer to all                    
patients, entering its hospital facilities, the opportunity to                 
complete an advanced directive.  When a patient expresses interest,            
a social worker is available upon request to help complete the                 
documents.  This approach has been very successful as far as                   
patient understanding of his/her options in terms of withholding               
and withdrawing treatment and it forces patients and physicians to             
communicate about the advance directive options in a thorough                  
manner.  It also gives the person with durable power of attorney               
the ability to withhold and withdraw treatment as needed if the                
patient is unconscious.  Staff clearly explain the difference                  
between an advanced directive and assisted suicide, given that                 
Oregon has such legislation.  MS. CARNEY said an advance directive             
does not substitute for conversation, because one might be kept                
elsewhere in a clinic file without the knowledge of the attending              
physician, so the document is not useful.  She reiterated she                  
strongly supports this approach and the way it has been adapted in             
SB 291.                                                                        
Number 174                                                                     
VIRGINIA PERI made the following comments on her own behalf.                   
Current Alaska law pertaining to living wills is overly broad,                 
speaks only to terminal illness, and needs clarification.  She has             
had five operations in six years but her wishes as a patient, as               
stated in her Alaska living will, were not honored in Alaska                   
hospitals because she was not terminally ill.  She chose to prepare            
a second living will in Oregon that speaks to serious medical                  
illness which was accepted in Washington State by the University of            
Washington Medical Center Hospital while she was treated there.  In            
addition, current Alaska law contains no definitions for life-                 
sustaining procedures and nutrition and hydration, and treats all              
equally.  Many persons enter a hospital without a living will and              
are not aware of their rights as a patient.  SB 291 clarifies the              
law to give greater understanding to those people using a living               
DEBORAH RANDALL, an attorney with the law firm of Davis and Davis,             
stated she worked with Virginia Peri on this legislation.  She and             
Ms. Peri believe tremendous advancements in the area of advanced               
directives and health care powers of attorney have occurred over               
the last few years.  Linda Emmanuel, working with the American                 
Medical Association, recently published a 12 page advanced                     
directive that outlines several medical conditions and the medical             
treatment options a person can choose to have or have not applied.             
Alaska's statute addresses one condition: a terminal condition,                
defined as "a progressive incurable or irreversible condition that,            
without the administration of life-sustaining procedures, will, in             
the opinion of two physicians, result in death within a relatively             
short time."  She stated under that definition leaves a lot of room            
for misinterpretation and could result in withholding CPR on a 40              
year old who had a heart attack because a heart attack can be                  
considered an irreversible condition. The Oregon statute is much               
more thorough and has passed the test of time.  It allows a patient            
to tailor his/her wishes to many different situations; i.e., it                
allows the patient to decide whether he/she wants every life saving            
measure taken for a terminal condition unless he/she is in a                   
persistent vegetative coma.  She suggested combining Alaska's                  
living will statute with the health care power of attorney                     
provision which currently consists of two lines in the general                 
power of attorney law.  In addition, she asked that provision be               
amended to allow an agent to withhold life-sustaining procedures.              
Ms. Randall stated her support of SB 291 and said it will create a             
win-win situation for all Alaskans.                                            
Number 249                                                                     
RICHARD WILLIAMS, senior representative of the Older Alaskans                  
Commission, testified via teleconference from Anchorage.  MR.                  
WILLIAMS said death does not frighten him, dying does.  Recent                 
advancements in the field of medicine allow doctors to draw out the            
process of dying as long as they wish.  SB 291 gives individuals               
the opportunity to determine how they want to die in certain                   
FRAN MCNEILL, Family Care Coordinator for Life Alaska, stated                  
support for SB 291 for the following reasons.  SB 291 honors the               
patient and family by allowing the patient the right of self-                  
determination and preserving the patient's autonomy. It enables the            
family and patient to look at some of the most pressing and                    
difficult issues surrounding the possibility of death prior to a               
crisis.  It also supports the community and gives people the                   
opportunity to choose whether to donate tissue and organs.  SB 291             
clarifies some of the complex issues we face resulting from                    
advancements made in the field of health care.                                 
TOM BULLER, Ph.D., a member of the Department of Philosophy at the             
University of Alaska, Anchorage, concurred with remarks made by                
previous witnesses, and added the following comments.  SB 291  has             
an ethical/moral basis and provides evidence of our respect for                
self-autonomy, self-determination, and individual well being.                  
Advance directive legislation allows an individual to determine the            
conditions under which he/she wishes treatment to be discontinued.             
The bill fosters physician/patient communication and allows for                
discussion about expectations of the quality of one's life.  He                
agreed with Ms. Carney that SB 291 in no way endorses assisted                 
suicide.  It deals with the right to refuse treatment.  The Supreme            
Court stated in two rulings last year that the right to bodily                 
integrity is very different from the issue of assisted suicide.                
Number 328                                                                     
MELBA COOKE, a case manager with the ALASKANS AIDS ASSISTANCE                  
ASSOCIATION, stated support for SB 291.  At present, her clients               
must write out everything they wish in regard to life-sustaining               
procedures; SB 291 speaks to everything her clients would                      
appreciate.  She agreed with previous speakers' comments and                   
encouraged committee members to pass this legislation.                         
SENATOR ELLIS pointed out the Legislature passed legislation                   
relating to advanced directives for mental health care by former               
Senator Reiger two years ago.  The Legislature is not plowing new              
ground in terms of the advanced directive aspect of SB 291, but is             
reviewing the current living will statute which is unworkable and              
inadequate.  He congratulated the sponsor for putting the bill                 
forward, and said he is glad to be a co-sponsor.  Senator Ellis                
maintained that advanced directives are allowed in the realm of                
mental health care, therefore the same reasoning should be applied             
to other areas of health care.                                                 
SENATOR GREEN questioned whether the new advance directives are                
complex and will have to be completed in consultation with an                  
MS. CARNEY answered no, the paperwork does not require a patient to            
meet with an attorney.  The Sacred Heart Hospital has prepared an              
educational booklet that contains definitions of terms and other               
detailed information for patients, and the hospital's social                   
workers review the documents with patients.                                    
Number 371                                                                     
MR. AMBROSE indicated the new advance directive is actually less               
complicated than the medical directive packet compiled by the AMA.             
The AMA packet gets into areas that most people do not even want to            
think about.  The problem with the current law is that it is so                
broad, specific instructions are frequently not carried out.  The              
Chase Review reports that a living will should state completely and            
explicitly those areas of health care about which the individual               
wants to make decisions.  He reminded committee members under state            
law, any attorney in Alaska must assist a person with a living will            
on a pro bono basis.  He noted committee packets contain a copy of             
the documents offered to clients.                                              
MS. CARNEY indicated PeaceHealth is investigating how to put                   
advanced directives on to a computer system so that patients'                  
wishes are readily available because sometimes records are not                 
accessible in emergency situations.                                            
Number 394                                                                     
SENATOR GREEN asked whether SB 291 mandates that educational                   
materials be provided to the patient.                                          
MR. AMBROSE replied it does not.                                               
SENATOR ELLIS moved CSSB 291(JUD) out of committee with individual             
recommendations.  There being no objection, the motion carried.                

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